TreatmentUpdate 76. 9(2): 10-11; March, 1997
Sean Hosein

The introduction of protease inhibitors has been associated with increased CD4+ cell counts and decreased amounts of HIV in the blood of treated PHAs. As well, some PHAs given protease inhibitors have recovered from previously untreatable complications, such as:

* the life-threatening diarrhea ?Crypto? (C. parvum)

* the brain infection PML

* assorted bacterial infections

* weight loss.

USA

Other doctors have reported alarming outbreaks of the sight-threatening complication CMV retinitis. Doctors in Buffalo (NY), Galveston (TX), Los Angeles, San Francisco and Tampa (FL) have documented 5 cases of CMV retinitis in people who had at least 200 CD4+ cells at the time retinitis was developed. About 1-2 months before diagnosis of retinitis, subjects had less than 85 CD4+ cells. They then began use of protease inhibitors as part of a combination anti-HIV therapy. Although CD4+ cell counts increased, retinitis developed.

Paris

Meanwhile, doctors in Paris, France, have found at least 8 cases of CMV infection among 210 patients occurring within 10 weeks of starting combination therapy with protease inhibitors. Their average CD4+ cell count before therapy was 37 cells and, despite having it increase to 185 cells, CMV flared-up an average of 37 days after beginning therapy. Five subjects were using indinavir and 3, ritonavir.

Rennes

Other doctors in Rennes, France, have reported 4 cases of herpes infection in the eye after patients began combination therapy with protease inhibitors. One patient had VZV (varicella zoster virus which normally causes shingles) infect his eye 8 days after starting use of protease inhibitors. Another had CMV retinitis develop 9 days after he began using ritonavir. The other two patients had their retinitis become worse shortly after they started using the same drugs.

Why?

The French researchers think that there are at least two possible reasons:

* protease inhibitors may weaken the ability of CD8+ cells to control herpes infections

* the same drugs could stimulate the growth of herpes viruses.

REFERENCES:

1. Jacobson MA, Kramer F, Pavan PR et al. Failure of highly active antiretroviral therapy (HAART) to prevent CMV retinitis despite marked CD4+ count increase. Abstract 353.

2. Gilquin J, Piketty C, Thomas V, et al. Acute CMV infection in AIDS patients receiving combination therapy including protease inhibitors. Abstract 354.

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